Introduction. Heavy metal intoxication after arthroplasty is extremely rare but could be lethal. Case Report. We report the case of a 69-year-old woman, who presented intense systemic symptoms of chromium-cobalt intoxication after revision of per-operative fractured ceramic components with metal-on-polyethylene. Systemic toxicity occurred a year after surgery and expressed brutally with mostly central neurological symptoms. Chelation associated with revision surgery allowed rapid regression of all symptoms. Conclusion. Revision of fractured ceramic, even per-operatively, should not be done with metal-on-polyethylene components, in order to avoid potentially lethal metal intoxication.

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Background The use of metal on metal prostheses (m-o-m) emerged in the last decade because the problem of polyethylene wear was avoided and they were supposed to have better survival rates. A meta-analysis reported survival rates of 95% for m-o-m prosthesis versus 92% for metal on polyethylene (m-o-p) and 88.9% for metal on ceramic. Several studies reported that wear rate in young, active patients was lower with m-o-m prosthesis. Purpose The main endpoint of this study was to assess the survival rate of m-o-m DePuy ASR devices and to analyse the principle causes of hip prosthesis failure. Another point of interest was to estimate the economic impact of revision surgery. Materials and methods Patients with DePuy ASR systems were recruited to analyse the incidence of failure. The global economic impact of revision surgery was estimated on the basis of the average costs of this kind of procedures, including indirect costs (10,000 € peri-surgical intervention). Results Eleven out of forty-five patients (two women) with DePuy ASR devices underwent revision surgery. Their average age was 57.5 years (35–76) and their BMI was 29.42 (19.48–43.58). The prosthesis failure was caused by: femur fracture (n = 2, 18.2%), relapsing luxation (n = 1, 9.1%), metallosis (n = 5, 45.4%) and unexplained pain (n = 3, 27.3%). The estimated cost of revision surgery in these eleven cases was up to 110,000 €. Conclusions The survival rate of DePuy ASR devices is significantly lower in m-o-m ASR prostheses compared to other m-o-m models, even lower than in m-o-p systems. It would be necessary to follow up the appearance of adverse reactions to health products in order to know their real performance. The sooner we detect these failures the better we can choose better alternatives. No conflict of interest.